ABSTRACT
This paper reviewed the 2002 guidelines established by the National Federation of Cancer Centres. A group of experts nominated by the 3 French Societies involved in the treatment of cancer pain (AFSOS, SFAP, SFETD), established new guidelines ratios for morphine switching and/or changing of route of administration, in patients for whom either pain was not adequatly managed or adverse effects were unbearable. After a rapid reminder of the pharmacokinetics and metabolism properties of morphine, experts explained why the theory of opioid rotation (oxycodone, hydromorphone, fentanyl, methadone, tapentadol) using fixed equianalgesic ratios is not any more appropriate for a secure clinical practice. In the light of recent publications enhancing our knowledge on the efficacy of new drug switching ratios and for changing the route of administration of morphine, the group of experts recommended to use reconsidered switching ratios favoring security upon efficacy, to minimize overdosing and adverse effects. Consequently, after the new conversion ratio (using slow release opioids) was applied, a second titration should be done by means of normal release rescue formulations for breakthrough pain episodes. A smartphone App. OpioConvert® will be available for rapid and secure dose conversions.
Subject(s)
Analgesics, Opioid/administration & dosage , Breakthrough Pain/drug therapy , Cancer Pain/drug therapy , Drug Substitution , Morphine/administration & dosage , Administration, Oral , Analgesics, Opioid/pharmacokinetics , Fentanyl/administration & dosage , Fentanyl/pharmacokinetics , France , Humans , Hydromorphone/administration & dosage , Hydromorphone/pharmacokinetics , Injections, Intravenous , Injections, Subcutaneous , Methadone/administration & dosage , Methadone/pharmacokinetics , Morphine/pharmacokinetics , Oxycodone/administration & dosage , Oxycodone/pharmacokinetics , Phenols/administration & dosage , Phenols/pharmacokinetics , TapentadolABSTRACT
Pain is frequent in cancer patients. To date, there is a consequent therapeutic arsenal so to manage pain; the different treatment strategies are the subject of various recommendations. Patients with cancer also frequently suffer from renal insufficiency, and this comorbidity may disrupt or jeopardize the analgesic strategy by changing the risk-benefit ratio of treatment options. This article provides recommendations for the use of drugs used for pain treatment after pointing out: 1) etiological and pathophysiological elements of pain; 2) therapeutic strategies for pain management; 3) data regarding renal failure in cancer and; 4) a point on drugs pharmacokinetics.
